Did Hospice rush your loved ones death?

Love101, those are my feeling exactly. If I had to do again I would not make the decision that I did . For me and my mom Hospice was the wrong decision. Every case is different, for some it is right. Peace be with you. There is none for me.

Everyone should remember that the caregivers have the final say in what drugs their loved one receives. Just say no if you do not like the way hospice is treating your loved one. But remember if they are in pain agitated and frightened helping to ease this things is the way to go if you do not want to watch your loved one suffer a horrible death.

My father had a rare illness and then had 2 massive strokes.After 5 days in a coma they asked what his wishes were and I said not to be in a home with no brain function and needing 24/7 help which he was heading towards if he lived. After consulting with the doctors nurses etc we gave permission to up the morphine to 40mg and they said he would pass on in a few hours and he did. I am happy my father got his wish and it made us The family at peace with the decision.. Everyone should be allowed to Die..

I am as well concerned, from everything I've read every time a patient received Morphine they went from being alert to gone. I had the same experience with my grandmother, she was up eating (very small amounts) and talking at home. The night of September 28th, my Aunt gave her the morphine, at first she refused to take it and even rolled her eyes, they said to give her half a dose every hour. The next day, she was unresponsive until that night at about 8:23, when her breathing slowed down, and she passed away with just me in the room sitting by her side. I just want to know how much Morphine hospice provides and if that could in fact, if prescribed or used improperly could lead to an earlier death. I've seen so many posts on so many different websites of cases like this, and I just want to know if I would have had more time with my grandma. We were not expecting her to pass away so quickly.

Chickadeegirl, so sorry about the passing of your Grandmother... please note that every person passes on their own timetable whether they get morphine or not.

It's my understanding that a normal dose of morphine is between 5 and 20 mg every 2 to 4 hours. For morphine to to speed up death, each dose would be over 200 mg. No doctor would order such an extremely high dosage.

My Dad was sick with pneumonia and was doing poorly at the hospital, once back at Assisted Living he perked up, was chatty, but couldn't eat due to aspiration [food/water going into his lungs], he was on Hospice.... I thought this was a great turn around for him.... but he passed in the wee hours of the morning much to everyone's surprise. He went peacefully.

The burst of energy is common in many people who are ill... they all of the sudden become chatty, want to eat, start looking bright and attentive, that can last for a day or for a week. Then the next day they are taking their final breathes, with or without morphine. Morphine is a comfort drug to help lessen any pain the patient might have.

My dad has Liver Cirrhosis with Hepatic Encephalopathy and Ascites, and he is diabetic. He has all the common symptoms of someone in his condition including spikes in ammonia levels for which he must take lactulose orally and sometimes by enema if required. He has been at a skilled nursing facility for the last three months and has been getting admitted at our main hospital (acute facility with ER) every month for being almost unresponsive. This time around however, the skilled nursing facility had to call 911 since my dad was not only unresponsive but had a blood sugar level of 33 which I have never seen with him before. During his most recent admission at the hospital, my dad required a paracentesis as he does every month at the least. This time however, they noticed that he had spinal cord injury at disc T7 (decompression is present on discs T5-T8) which by itself is very rare and this made him a paraplegic the same night after getting his paracentesis, which was December 27, 2016. During this stay at the hospital the case manager recommended certain companies for Hospice which adhere to "their strict standards of quality." I selected one of the companies from the list provided to me by the Hospital's case manager. The next day, the hospice representative met with me and my mother to explain the care my dad would receive at the skilled nursing facility under hospice care. The next day, my dad was discharged from the hospital and transported by ambulance to the skilled nursing facility where he would receive the hospice care. The next morning, my mother visited my dad at the nursing facility on the way to her work to see how he was doing and during this time she was informed by a nurse of the hospice company that he would have a nurse by his bedside for the next 24 hours or longer. I then stopped after work to see my dad and there was another nurse from the hospice present who informed me that she had just given my dad some morphine and ativan after I specifically asked her. I got home after my brief visit and put together what the nurse placed by my dad's bedside by the hospice agency was up to who was given orders by the hospice's doctor and not my dad's pcp, mind you for the morphine and ativan periodically until his death. I, my mother and my brother visited the facility last night and after being ensured by the answers I was given and not given on the fact that my father was being put to death by morphine and ativan by the bedside nurse whose paperwork showed that she had written my dad's diagnosis as liver cancer. Let me make it clear that at no pint has my dad been diagnosed with liver cancer; I understand that his condition can progress and his cirrhosis can turn into cancer but this is just not the case at the moment. I called 911 and had him transported to the ER at my local hospital. The EMT's gave him Narcan to block the morphine's affect. While at the ER he was given several medication to stabilize however much they could. As I am writing this at 7:37 AM on January 12, 2017, I and my family cannot still believe what just happened! Were it not for my intervention and had we just delayed our visit a bit longer, my dad would have been dead by means of ativan and morphine given over time to cause his death. I stayed all night long at the hospital and talked to several nurses and a nurse practitioner who informed my that one of the complications from my dad's hypothermia is pneumonia which my dad developed thanks to the hospice. I am totally shocked at what happened and we are discussing what steps to take next.

Update to my post of 21 hours ago.. My father passed away today at 6:55PM at Methodist Hospital in West Houston. I am still trying to process what has happened.

I'm so sorry for your loss! Is it possible that your dear father had a diagnosis of liver cancer that he and/or your mom was keeping from you? Even if he didn't have cancer, it sounds as though he was quite seriously ill with no chance of recovery, which is why hospice services were recommended, to give him pain and symptom relief.

You should certainly check the dosage of morphine that was scripted by the hospice physician; the nurses could only administer what was ordered by the physician.

Again, I'm so very sorry that you've lost your dad.

Dear mfatah so sorry for the loss of your Dad, and condolences to you, your mother and brother.
Everyone wants their loved ones to live as long as possible and the death triggers the normal stages of grieving which involve disbelief and anger.
It is clear from your post that your father was already in the final stages of his life and your actions were very understandable. His condition when he was awake and aware would have been distressing to him and for you to continue to watch.
You and your brother did what you felt was right at the time and you are perfectly correct in wanting to find the facts.
I would suggest you write down what you have told us and everything else the family observed. Your mother can obtain a copy of his hospital and skilled care facility record which will include the nurses notes and medication orders.
It is usual in a nursing facility for that facility's MD to take over the care of the residents there and write the orders. In the case of hospice patient's the hospice MD may or may not be involved.
Once again I will stress that no nurse can give a medication that has not been ordered by an MD, FNP or PA. it is illegal they would loose their licenses by doing that.
Hospice never deliberately causes a patient's death. That would be murder. They may however find it necessary to give drugs to control certain symptoms like pain and anxiety which can lead to excessive sedation, unresponsiveness and lead to pneumonia which may be fatal. most families want to see their loved ones pain free and calm in their final hours.
At this time try and concentrate on laying your father to rest and grieving his death.
It is very difficult to loose a parent or spouse. After things are calmer in a few weeks revisit your concerns and it will then be clear to you if they are justified and what if any action you wish to take. Be aware though that revisiting this time will again be very painful so some grief counciing may be helpful. Hospice does offer this service for 13 months after a loved ones death and may be individual or group or both depending on your needs.

Mfatah,
I'm very sorry for the loss of you dad. My heartfelt sympathies to all your family members.
I'm a hospice nurse. From your very accurate description of your father's conditions, he was a seriously ill man. Patients do not recover from these conditions and his diabetes added to the problem. The swollen abdomen from the cirrhosis and acities can cause great pain and discomfort. Draining off the fluid from the abdomen is also uncomfortable but does provide temporary relief. The fluid returns and it is a continous cycle to keep the patient comfortable.
I need you to know that hospice nurses keep the pain and anxiety medications in the same room as the patient. That's a common practice. Morphine (a narcotic used to treat pain and/or labored breathing) is ordered in specific doses by the hospice Doctor. The same with Ativan (an anti-anxiety medication). A nurse CAN'T give more than what is ordered by the doctor. We have a system for accounting for each dose of medication that is given and it is double checked with another nurse at the beginning and end of every shift. If it isn't correct, there would be all kinds of investigations to find out why there is a discrepancy. We can't just give as many pills or liquid as want to the patient. We are not there to kill your family member!! We are there to watch for symptoms your dying loved one is experiencing as pain or anxiety. We use our observations of patients grimacing, frowning, moaning, rocking, rubbing an area, repositioning, gritting teeth, flailing arms and legs, hollering out, making fists, or we ask them (if the patient can answer) to guide us to know how uncomfortable they are. We try to keep these symptoms at a minimum or absent altogether. Our mission is to have the patient be comfortable so they can rest and be relaxed. A struggling death is a horrible sight.
The amount of medication given per hour is not enough to take someone's life. Yes, they may be in a deep rest but they cannot die from the quantity of meds given. I used to work the surgical floor in 2 hospitals and have I've given more morphine to post-op (post surgical) patients coming right out of surgery than I give to hospice patients. I'm sorry your dad had to go ER and receive Narcan
(a narcotic antagonist that reverses any effect of the narcotic) to then suffer pain again since he passed within a few hours. Too bad that he couldn't have been more comfortable. That's what hospice is all about.
I'm sorry you feel we are to blame for your father's death. As you can see, it was imminent even without our interference.
FYI, a dose of 200 mg. or more is needed to kill someone. 'Typically' hospice doctors order 7.5 mg. to 15 mg. every 4 hours with the same amounts that can be given every hour for "breakthrough" pain (pain that wasn't taken care of by the initial dose) if needed. Can you see how these doses don't come close to killing anyone?
Many people want to blame someone or something for taking their loved one. It was just his time to go and I'm sorry. I lost my dad too so I know your heartache. Be comforted that your father is no longer suffering in a malfunctioning body that was causing him great discomfort.

SueC1957, Great post on the Hospice thread! I too, have lost a Mom, battling Cancer, on Hospice, and I don't know what we would have done without You All!  You are Angels from Heaven, IMO!

I like the way you spelled it out so nicely, that Hospice Nurses do not give enormous amounts of Narcotics and kill people, nor Ever administration more, then the Dr prescribed!

You were clear, consice, and very considerate! It must be very difficult to always have to defend your talent, your vocation, unfortunately, people who are grieving, sometimes need to blame somebody, when they lose their LO's, even when acutely ill, and death is imminent. Unfortunately they hear the word Narcotics, and based on the bad press in the news,  wish to blame the use of these, when used in the Right context. I know that many other Nurses on this one and simular threads on here, have done the same, but people don't want to hear the truth, plus, people are just plain scared, scared of their LO passing, and they themselves being in charge of these types of medications, especially at the very last panicking moments, it is extremely scary, So I can understand their reluctance to wish to administer them.  It's a sad and scary time, but they shouldn't be blaming the Hospice for trying to eases their LO's pain, anxiety and suffering.

But good description, great educational information, and THANK YOU, for all you do as a Hospice Nurse! It takes someone extremely Special, to be able to work as a Hospice Nurse, and not everyone can do it.

Hypothermia is a severe drop in body temperature, usually caused by exposure to cold weather. Since your dad was in a facility, I'm sure the ambient temperature inside was comfortable (70+ degrees). Morphine does NOT cause hypothermia. As the body shuts down, circulation slows, making hands and feet, then arms and legs feel very cold to touch. This is part of the dying process.
The pneumonia is not a direct result of taking Morphine but Morphine does slow breathing. During the dying process, patients accumulate secretions (mucous) and can not clear them. If the mucous is close enough to the throat to suction out, the hospice nurse can do that. Patients may attempt a cough but, as the body is preparing to stop functioning (die), the secretions collect in the bronchus, creating a heavyly congested sound-referred to by some as a "death rattle". In the hospice I work for, our doctors prescribe Levsin, a drug to dry up the mucous, to make the patient more comfortable.
Other meds we use are Tlyenol for fever and meds for constipation. These are all for the patient's comfort.

MFATAH, I am so sorry for your loss, it is so painful, to lose our parents whom we love so much. My thoughts and prayers are with you and your family now, and in the coming weeks. Take care.

Thanks Stacey,
Yup, you're right. It does get tiring telling people that we aren't killing their loved ones. It's a matter of the family being under-informed. We could have possibly missed giving some information upon admission. However it's common that the family members can't process all the information they are given, due to their anxiety and grief. The process IS explained to them (whoever is there) but, often you have more family appearing (who haven't been informed) and they pitch a fit. I can't tell you how many times I have encountered this. Just last week I was asked by a grandson when grandma was going to sit up and eat again!! It was a breakdown of FAMILY communication that caused this. I tactfully attempted to spell out reality-with all his aunts and uncles (the dying patients children) watching!! Shouldn't THEY have prepared him before he got to his grandmother's room?
So thank you for cheering us on. We're only trying to help make the transition a comfortable one. It's good to hear that you had a positive experience.

SueC1957, I'm one of 6 kids. We had just lost our Dad to a Parkinson's like disease, and right in the middle of our Mom undergoing 60 days of Radiation therapy, to treat her aggressive Uterine Cancer.

About 5 months post treatment, Mom's bones started breaking apart from the metastatic cancer, she was treated in the ER for intractable pain, multiple pelvic fractures, admitted, and a couple of days later, sent home to my sister's home on Hospice care, and a
PIC Line, for IV Morphine, she would have for pain, until the very end.

Thankfully, I worked as a Medical Assistant, and had a Little clue as to what was to come, but you are Right, you are overwhelmed at first, hit with the thought that you will be losing your Mom, probably within 6 months. Meeting the Hospice team, setting up a rotation of siblings (now Caregivers), the Hospice aides, bathI got aides,  clergy, and  other caregivers, so my eldest sister wouldn't get completely  burned out, and finding a Grove. It is Overwhelming at best!

 Our Mom was on Hospice for 5 months, so we had an adjustment period, but Many People, Many Families Don't anywhere near that amount of time.  

Having a LO come home on Hospice care,  only to pass within days or weeks,  is Extremely Stressful!  Then  Realizing, and Understand  that You may need to The One who must Administer such Powerful Medications, at the Most stressful times, when your Loved one is struggling and panicking, well, it's Not for Everyone!

However, EVERY family who does Accept and Admits their Loved One into the Hospice program does have a meeting with the Nurse, the Social Worker, and had the opportunity to ask questions. They are also given written materials for review.

The medication potentials are discussed, as in my understanding, every patient receives an Emergency Medication kit, and the patients LO's are supposed to know it's use and be able to administer it. The Nurses are Always a phone call away, 24/7!  Believe Me, you are calling them Constantly! 

All the medications are Rx's by the Hospice Dr's, and the Nurses are to administer it AS WRITTEN. Never do the "up the dosage", willy-nilly, or as they see fit. The Nurses work within the confines of their Licence, or they would Lose that Licence. All medications are Charted, and strictly monitored!  Many times, it is the Primary Caregiver and other Family members who are dispensing the medications!  Often hard core Narcotics.   Remember,  Hospice Nurese ARE NOT there with you (for the At-Home Patient) all the time, or even every day! But are always available by phone, 24/7.

People who are admitted to Hospice Care normally know, that they are Nearing the End of their Life, or the Healthcare POA does, and is acting on their behalf.

Hospice is for Comfort Care, a humane and as Pain-Free, and Stress-free time until death, as can possibly be made for the patient, by the Hospice team. You (as a Caregiver), Are Part of the Hospice Team!

Our Mom went to the Hospice Hospital, the last 8 days of her life.  The Nurses were able to see signs and symptoms that We, her Children could not see.  Her frail, sick body was shutting down.  She had some mental decline as well, that we did not see.  Sometimes, the family Caregivers are "Too Close", and not seeing subtle changes, that the Nurses do see in their examinations, so as recommended,  our Mom went In-patient.   

It was definitely for the best, as in our large family,  there was 16 Grandchildren, and 3 Great-Grandchildren involved in our situation.  It was near the end, our Mom was Atively Dying, and it was felt it might be too traumatic for the younger children, to have Mom die in my sisters, and my Mom wholeheartedly agreed.  She was the Ultimate Mother and Grandmother,  who Loved her whole family and everyone,  including her Hospice team! 

Hospice is about the Whole family,  not only the Patient.   The Hospice Hospital  was amazing to her, as well as our family.   Our Mom passed away Peacefully,  with all 6 kids holding onto her, and onto one another. 

Hospice IS NOT for everyone, OR every family. There are a LOT OF MOVING PARTS!

Please, know what you are getting into, and ask a lot of questions! It takes a village! Literally!

Just reflecting here. I think many people do not think about how long someone was under hospice care before the meds necessary for comfort started being administered. My mom is under hospice care, has been for two months now. She is now declining rapidly, they are trying to figure out what meds may help. They have not discovered it yet. What is most important is that mom is comfortable, regardless of the meds that are being administered, they will keep her safe, and others. They have had to start 24/7 private caregiver again so she has company, which seems to be helping. But still she is very close to the end I think. I pray that it will be a comfortable time for her, and that the hospice is able to figure out what will help her make the transition.

staceyb
What you posted about Hospice was definitely not how it went for my mom. My experience, no meeting with nurses, or hospice team. Just a call from ICU head, subtly suggesting life support be ended. He used her age, what her body was going through with meds, how religious he is, etc. Hospital made decisions that best suited their needs instead of the patient or family.

It's been 6 mths since she has passed. Since that time, no communication from hospital, Hospice, or "concerned" doctors. In a weird way, it is a blessing, since hearing from them would be hypocritical.

...Just so some of you know, unless the hospitals, doctors, NH, AL,etc are the rare ones that really care, unless there is a balance for any care done, don't expect to hear from any of them after your loved one passes.

I cannot for the life of me even understand why this thread, which apparently only feeds people who are in denial of very sick, old people, dying.....continues....

Do you think I am rude or dismissive of your grief???.....No....I absolutely feel your grief and sorrow.....I have felt it many, many times myself.....BUT GET REAL....older, very sick people die....as do we all, eventually....

How YOU deal with it reflects only on you....READ: Dr. Atul Gawande's excellent book: "Being Mortal"

And, I speak as someone whose lovely, very elderly Mom has just passed, very peacefully, after 6 months on hospice.....no big rush to "kill her", there....

I also speak as someone who was widowed very young, very suddenly, in a country half way across the world. My husband was granted a very great honor....a Hindu cremation.....I am not going to share 1 second of that with you. Those are my very personal memories. But....I will say this.....

As my husband's service concluded, a little donkey wagon approached....it was decorated in ribbons and feathers and bore the next recipient's of this priest's good intentions: it was a wedding ceremony, and quite lovely, and it, still to this day, makes me feel hopeful......about the circle of life....

Zythrr, I can't begin to understand the intense anger and sadness you feel about the end of life decisions that were made by the Drs, for you Mom, you and your family. I definitely feel the pain in your posts. I am sorry that you didn't get the compassion that was so needed in your situation.

From the sounds of it, your Mom was on life support, and that's never a good thing. It sounds as if the intention was there, that if your Mom survived being taken off life support, then Hospice would be brought in to help her through to the end of her life, but she unfortunately did not make it after it was stopped. A decision that You didn't necessarily agree with or completely understood yourself.

It is so Painful, to lose our Mom's. It's been 13 years for me and at times, the pain of not having her here overwhelms me to this day. My Mom was so young, only 74, and she didn't deserve to get such a wicked Cancer, such a painful disease, that cut her life short. I'm sure you feel the same.

I'm so sorry for your loss! Not everything makes sense, when it comes to death and dying. It is often so completely out of our hands. Like you, I wish I still had my Mom by my side. Life just doesn't always make sense.

You take care.

staceyb

Thank you so much for your post. It has really helped, Bless you. I'm sorry for the loss of your mom as well. You're exactly right, it is very hard.

I'm not as angry as much as very disappointed. There were 3 nurse "angels" who were really sweet and caring. The doctors and his staff were the "cold" ones. I understand, not getting emotionally involved, because of the risk of burn out. Still..

I know the survival rate from Sepsis, especially for older people, is not that good, but the "pressure" to move her to a facility where he visited was too much.  One of his staff was actually "pissed" that one, she could not make the choice for her, and second, the choice that was made, even though he could still visit was for only 30 days after which she could choose again where she wanted to go.
Like I posted on cdnreader's thread , being angry you're only hurting yourself, not the person you're angry with. The best antidote for anger is to forgive, which is what I am doing in this case. Needless to say, trust in healthcare is gone

Thank you so much again. You've helped more than you'll ever know. 
Take care as well.

Zythrr, you are Welcome! Losing a parent is a terrible time, and we all have different experiences with it.

I know that I am one of the lucky ones. Both of my parents were dying for a long enough time, that we (my 5 close siblings), had a chance to come to grips with it. There was nothing we could do, to prevent the outcome, no matter how we tried.

I believe knowing that, and having the support system that I had, made all the difference.

I wish more people had that.

It doesn't mean that it wasn't a very rough journey at times, but we always had each other.

Take care, and I'm glad to have had the chance to connect with you, over some very unfortunate circumstances, but we all are HERE, for each other!

i thought i was alone in my feeling very pressure to keep giving the meds so often every 2 hrs at a high doses of 2 drugs. im helping them they need me to be strong and helping them die. i didnt think she was ready i fought until my 1st born son died suddenly. i still cant deal w/ my son,at the same time my mother 67 yrs young she was Noreen Anderson she suffered they made me kill my mom is so dramatic??? im not looking for anything but answers others maybe can relate. its too hard to put in a message im lori an only child no dad just mom and me so were very close more then most. grateful to you what who can help me.

LoriA, I am so sorry for the loss of your dear Mom, I do know how hard it is, as I've lost both of my wonderful parents, taken too young, with still so much zest for life. My Mom was on Hospice too.

May I ask you, what your Mom's ailments were, that required her to be on Hospice? It's such a shame, you losing your Son, while your own Mom was so sick, nobody should ever be faced with such a loss, I am so sorry!

What you do have to do is quite blaming yourself. Your Mom met the Hospice criteria, or she would not have been admitted to their care. That you feel to blame for her untimely passing could not be further from the truth. Your Mom had a very bad illness, that required her to take potent medications, perhaps for pain, and of course you wished to keep her as pain free as possible, right?

You could never have given her a dosage, that would have brought her death on any sooner, than her illness would have taken her in the first place, and what you did do, was treat her ailments, in the manner in which the Hospice Dr's recommended. God takes people in his own time, not on anyone else's timetable. Please, never think that!

We all go through the different stages of grief in our own way, and the Woulda, Coulda, Shoulda's, often come into play in those stages, and in no particular order.  So at this point, the very best thing you Should do for yourself (besides joining us here), would be to join some grief counseling. It will help you to understand how to address your different stages of grief, and how to go on in life, without your Mom, Your best friend in it. It takes time.

God bless, and I hope you come back, and share your experience and your healing process. We all learn from one another.

Hi I jus stumbled upon this and I did question myself about my dad's death. It took me almost a year to get to my senses and think clearly. I recently felt as if I shouldn't Hav put my dad in the hospice

To all who have posted here. Thanks for the insight on Hospice and morphine. Not everyone's experiences have been bad. My mom has been on hospice for almost a month, here at home with her family. The nurse visits twice a week and the home health aide does as well. They have been very informative on all that is going to happen. The Care package with the morphine is for the pain and comfort to both the patient and the care giver. My mom would gasp for air prior to the issuance of the morphine. Now she does not. knowing my mom as i did, she would not want to live in the bed and have people take care of her, she like to go out and do things and now she can't, she is unresponsive for the past week and i believe that we are close to the event. This has been along drawn dying process since her stroke in Sept. 2016, she had the forethought to have advanced directives so there would be no doubt what her intentions are. it has been tough to follow the directives but when you know somebody really well, you do what you can to honor their wishes.

Atolbert I am so glad you have found the strength to follow your Mom's wishes.
That is the most important thing to keep in the forefront of one's mind.
What did he/she want or would have wanted?
It is about the person who is about to leave this world not those who must stay behind and grieve.

Veronica91 it has been tough and to make sure that my siblings feel the same way i do.

For those of you who don't know, I'm a per-diem (on call) hospice nurse. At our hospice we have weekly nursing visits for stable (dying) patients and we also provide "crisis care" which is having a nurse stay with the patient for 8 hour shifts (24 hrs+), IF the patient has out of control symptoms, constant pain, constant vomiting or severe uncontrollable shortness of breath. That's my job, getting the patients to a comfortable point.) Then the family can resume the care.
(Not all hospices offer this service.) Once the patient has leveled out, they go back to weekly (or more often) visits.

I had to go into the (hospice) office yesterday to complete mandatory annual training and review. While I'm not able to disclose the name of the hospice I work for, I'm finding out that all hospices are not created equal. They do not have the same stringent rules and regulations that we abide by. Some of the computer classes that I watched gave examples of how other (unnamed) hospices functioned. I was really surprised at the breaking of known rules and regulations. (This is the only hospice I've ever worked for and I assumed that we all operated the same.)
I should have known when the largest hospice (1000+ patients) in San Diego county had their doors (forcibly) closed due to many different infractions. Everyone was shocked. It never dawned on me that someone would forge a signature, not show up for a shift (and chart that they did!!!), or any of a number of infractions. The leaders at my hospice use these examples as how NOT to function. We are expected to know what is right and wrong and we are tested at least annually, checked and reviewed by our supervisors, peers and patients/families. We have a zero tolerance policy for any infraction. It's too bad that other dishonest companies exist but we learn from their mistakes so we don't commit any with our patients.

I see now why some of the families have written about their bad experiences.
Please check with the Better Business Bureau, Google Medicare-hospice, Yelp, hospice regulatory board, etc.
I'm sure there is a site that would list ratings of hospices or infractions committed by them in your area. (I'd look it up myself but, when I leave this page, it deletes everything I've written!) Do not sign up with a hospice that offers you "gifts" (TV's, trips, etc) to sign up your family member. ( That should be a red flag!), or that didn't thoroughly explain every facet of hospice to you. Medicare has VERY strict guidelines for how hospices operate. They would be a good site to visit. "Medicare/hospice coverage" probably would get you some good information. Beware of any who forces you to do something you don't want to do. You are the expert on your family member and we take our cues from you.
Investigate, don't just take the hospitals' word, or a social worker's word. Hopefully you will wind up with a high quality hospice that will meet your and your departing family members ' needs.
Respectfully,
Sue

Sue C thank you for posting your experiences as an on call nurse for hospice. They absolutely mirror my own working for a small non-profit hospice.
I have long felt that the large hospice "businesses" do not uphold the hospice spirit when money making is the main goal.
I have been retired now for 9 years and before that had the job of full time on-call for 10 years.
In the late 50s I worked in London at the time Dr Cecily Saunders was starting the modern movement. I once escorted a patient to a hospice facility and at that time it was very similar to long term geriatric wards, not at all like modern hospice houses.
Naturally I don't agree with many of the posters on this particular thread but I do feel every one should do their due diligence before signing up their loved one.